Stent retriever for dilation of pancreatic and bile duct strictures. brand@uke.uni-hamburg.de.

BACKGROUND AND STUDY AIMS

Dilation of high grade strictures of pancreatic or biliary ducts using dilating or balloon catheters may fail. We evaluated the efficacy of the 7-Fr Soehendra Stent Retriever used as a dilator.

PATIENTS AND METHODS

Following sphincterotomy, the stricture was first negotiated with a 260 cm long 0.032-inch J-type Terumo wire. Dilation was then attempted using a 7-Fr dilating catheter. If the stricture could not be traversed, the 7-Fr Stent Retriever was inserted over the Terumo wire to dilate the stricture. Between May 1996 and January 1997, the Stent Retriever was used for dilation in 32 patients with biliary or pancreatic duct strictures.

RESULTS

The indication for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) was symptomatic chronic pancreatitis in 21 patients (twelve men, nine women; mean age 45.7, range 26-70). The mean length (+/-SD) of the pancreatic duct strictures was 20mm+/-10 (range 3-55) with a prestenotic ductal diameter of 9mm+/-2 (range 2-15). Out of 21 patients, nine suffered from pancreaticolithiasis and were treated with extracorporeal shock wave lithotripsy. All but three patients underwent successful stenting in the same session. Another 11 patients (four men, seven women; mean age 67.4, range 47-85) had cholestasis because of benign or malignant bile duct strictures. The mean length of the strictures was 20mm+/-5 (range 3-40), and the mean prestenotic diameter was 10mm+/-5 (range 4-21). Stenting was easily done in all of these patients in the same session. Symptom relief was observed within the first week after stenting in all patients with a biliary or pancreatic stricture. In seven cases, material for cytological examination was obtained from the bile duct, which revealed malignancy in two cases. There was no complication associated with the use of the Stent Retriever. One subcapsular liver perforation was caused by the guide wire and occurred prior to the use of the Retriever.

CONCLUSIONS

Tight pancreatic and bile duct strictures can be dilated successfully with the Stent Retriever. The procedure is of low risk. In addition, tissue sampling is possible in some cases.